Ultrasound to Confirm Central Line Placement

Yes, it can be done – probably.

This is a meta-analysis and systematic review of 15 studies comparing ultrasound to conventional chest radiography to confirm central line placement – and to determine any malposition. There is good news: ultrasound reliably detected the few reported pneumothoracies, and was nearly 100% specific for catheter malposition. However, there is also bad news: sensitivites for catheter malposition were all over the map, and the quality of the included studies was universally poor and prone to systemic bias.

It does seem to be a little self-fulfilling to use an ultrasound to place a catheter – and then to turn around use your skills to verify placement. After all, the operator placing the catheter is highly vested in the catheter placement being correct. That said, some of these data are likely valid – an experienced operator can probably use anå ultrasound to verify the location in the correct vessel when a catheter tip is noted on high-quality visualization of either the correct or an aberrant location. Chest x-ray is hardly a foolproof gold standard – and there may be clinically important ramifications to the delays in obtaining chest radiography. Due to the wide ranges of sensitivity, however, any effort to routinely utilize ultrasound for this purpose should be carefully followed by a quality assurance program.

“Diagnostic Accuracy of Central Venous Catheter Confirmation by Bedside Ultrasound Versus Chest Radiography in Critically Ill Patients: A Systematic Review and Meta-Analysis”

https://www.ncbi.nlm.nih.gov/pubmed/27922877